Sleep disturbances are common among individuals living with dementia, often becoming a major source of stress for their caregivers. These issues can take many forms, from insomnia and frequently waking up at night, to excessive sleepiness during the daytime.
Sleep plays a vital role in maintaining overall brain health, and for individuals with dementia, quality sleep is even more critical. Adequate rest can help reduce or delay cognitive decline by allowing the brain to repair and consolidate memories, regulate emotions, and flush out toxins associated with neurodegenerative diseases.
Poor sleep, on the other hand, worsens confusion, irritability, and memory issues, accelerating the progression of dementia-related symptoms. Ensuring that individuals with dementia get restful sleep is essential not only for improving their cognitive functioning but also for enhancing their quality of life.
Why Sleep Issues are Common in Dementia
Sleep problems are prevalent in people with dementia due to the changes the disease causes in the brain. The degeneration of neurons affects areas responsible for regulating the sleep-wake cycle, including the circadian rhythms (The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2022). As a result, individuals may experience disturbances like fragmented sleep, confusion between day and night, and less time spent in deep, restorative sleep.
Several factors can contribute to sleep problems in people with dementia, including:
Brain Changes
The areas of the brain affected by dementia, such as the hippocampus and hypothalamus, play a crucial role in controlling sleep. As these regions deteriorate, the ability to maintain a normal sleep cycle diminishes.
Medical Conditions
Chronic pain, arthritis, sleep apnea, and other co-occurring medical conditions can worsen sleep quality. Restless leg syndrome, a condition in which individuals feel an uncomfortable sensation in their legs and an overwhelming urge to move them, is also common among older adults and can lead to fragmented sleep.
Medications
Certain medications prescribed to manage dementia symptoms or other conditions, such as antipsychotics, antidepressants, and sedatives, can interfere with normal sleep patterns.
Behavioural and Psychological Symptoms of Dementia (BPSD)
Anxiety, agitation, depression, and hallucinations are common symptoms of dementia and can contribute to sleep difficulties.
Sundowning, a phenomenon where individuals become more confused and agitated in the late afternoon or evening, can also disrupt sleep.
Environmental Factors
Factors such as insufficient lighting, too much noise, or an uncomfortable sleeping environment such as too hot or too cold can further exacerbate sleep disturbances.
Practical Strategies for Addressing Sleep Issues in Dementia
Though sleep problems in dementia can be challenging, there are several strategies that caregivers can implement to promote better sleep for individuals with dementia.
Create a Consistent Sleep Routine
Establishing a regular sleep schedule can help reinforce the body’s internal clock. Encourage your loved one or client to go to bed and wake up at the same time each day. A calming pre-bedtime routine, such as a warm bath or listening to soothing music, can signal to the brain that it is time to sleep. Some people have reported difficulties with sleeping if they have cold feet. Perhaps investigate if this could be the case for the person you are supporting.
Improve Sleep Hygiene
Sleep hygiene refers to the habits and environmental factors that support good sleep.
For individuals with dementia, ensuring the sleep environment is comfortable (including temperature), quiet, and conducive to rest is crucial. A well-ventilated room, a comfortable mattress, and minimal light and noise can create a calming atmosphere. Dim lighting in the evening and brighter light during the day can also help regulate the sleep-wake cycle.
Encourage Physical Activity During the Day
Keeping individuals with dementia engaged in stimulating activities throughout the day can help promote alertness and reduce excessive daytime sleepiness, which in turn may improve their ability to follow more regular sleep patterns at night. This approach not only supports better physical and mental health but also reinforces the natural circadian rhythm, making it easier for them to feel tired in the evening and fall asleep more easily.
Address Medical Issues
If sleep issues stem from underlying medical conditions like pain, sleep apnea, or restless leg syndrome, it is essential to address these with a healthcare professional. Managing pain or sleep-related disorders can significantly improve sleep quality.
Limit Naps and Stimulants
While short naps may be beneficial, excessive daytime napping can disrupt nighttime sleep. Encourage your loved one to stay awake and engaged during the day to improve the likelihood of sleeping through the night. Caffeine, nicotine, and heavy meals should also be avoided in the hours leading up to bedtime.
Manage Sundowning Symptoms
To effectively manage sundowning symptoms, it’s important to create a calming and well-lit environment in the evening while incorporating structured activities that provide a sense of routine. Offering reassurance can help alleviate anxiety, even if the concerns seem disconnected from reality; for instance, saying, “Your parents are fine and plan to visit in the morning,” can be soothing. These strategies not only support individuals experiencing sundowning but also foster a sense of comfort and security.
Use Medications as a Last Resort and ONLY AFTER Other Alternative Strategies Have Been Tried Out First
While sleep medications may be necessary in some cases, they should be used cautiously. Many sleep aids can increase confusion, and risk of falls, and have side effects that worsen cognitive symptoms. Always consult with a healthcare provider before introducing any new medications or changing existing ones.
Sleep disturbances in dementia can be overwhelming, but with a proactive approach, many of these challenges can be managed. By establishing a routine, addressing medical conditions, and creating a restful environment, caregivers can help improve sleep quality for individuals with dementia. In turn, this contributes to better cognitive functioning and quality of life for both the person with dementia and the caregiver.
At Dementia Solutions, we’ve made it our mission to demystify dementia behaviour and continue to explore person-centred, creative, non-pharmacological solutions to manage dementia-related behaviours. We believe that awareness creation and skill-building through education is the most effective and powerful tool we have to promote and maintain the well-being of both the person with dementia and their caregiver.
If you need support in your caregiving experience or would like to learn more about our educational opportunities, please reach out to us at [email protected] and we would be more than happy to support you.
DISCLAIMER:
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.
